Thursday, March 28, 2013

Rockar Urges Physical Therapists to Prepare for April 1 Medicare Cuts

Many
physical therapists still may not be aware of the payment cuts that go into
effect April 1. In a recent blog post, APTA President
Paul A. Rockar Jr, PT, DPT, MS, urges physical therapists to review information
at APTA.org and share it with colleagues to prepare for these reductions.
APTA's 2013 Medicare Changes webpage
provides the information that physical therapists need to know about the
increase in the multiple procedure payment reduction (MPPR), and independent of
the MPPR, the Medicare sequestration cuts.

Comments

Is there not any chance that this will be delayed? Is APTA working on an eleventh hour stay? This is going to force many therapy clinics to opt out of Medicare or possibly even close their doors. It is happening at the same time Medicare is requiring more and more of our therapists...yet they want to pay less and less. I fear for not only our therapy providers and their livelihoods, but our elderly who will have difficulty finding care. Sad state of affairs.

Posted by Cheri Freeman, CMRS
on 3/28/2013 7:19 PM

After 42 years, I have given up . Sold my practice. Did not want the hassle anymore. The unfortunate thing----I loved what I did each day.

Posted by Charles Krpata
on 3/29/2013 2:39 PM

What are we doing about it? Well the short answer is reducing staff pay to account for the Medicare payment reduction. No one will be able to keep paying staff the same rates if reimbursmsnet is going down. There is no room to absorb the reductions any other way.

Posted by Russell
on 3/29/2013 3:15 PM

I support Cheri's comments, and also worry for the care for our parents (and ourselves!). Additionally, it is too bad that the "fixes" being discussed and implemented are built on the faulty concept that providers want to cheat the patient and insurers, and the only way to improve care is to demand more time (money) be spent by the provider to do paperwork, rather than on provider training, equipment upgrades or the like.
There will always be cheating providers, and they need to be aggressively pursued, but the rest of us are being penalized by these onerous requirements that only decrease the quality of care we can afford to provide.
In the end, we are business and if we are cannot pay our bills out of our reciepts, then we cannot afford to provide services.

Posted by Tim Paine
on 3/29/2013 3:25 PM

Could not be stated any better than that.

Posted by Raymond Mack PT,MA
on 3/29/2013 4:10 PM

Cheri,
I could not agree more. Scary future...

Posted by Ryan Kalman -> >ISZEK
on 3/29/2013 4:58 PM

TIm put it quite correctly. They want to cut back the reimbursement to providers. They do not realize that many of us will opt out of medicare and make healthcare accessibility more inaccessible to our seniors. We are one of the most cost effective ways to health. They would rather pay the hospitals, imaging companies, and pharmaceutical companies. The bean counters are too stupid to realize this is just a band aid. What next? Should we give away services. Obama and his buddies would love it.

Posted by Bill O"Grady
on 3/29/2013 7:16 PM

Bleak future for us BabyBoomers; even more bleak for our children.
I have no staff, just me. This eliminated workers comp insurance, payroll matching taxes and benefits: health insurance (exponentially rising in cost also due to the Obamacare) PSP/401K.
I paid off the commercial building loan; no mortgage, no rent.
After 8 hours of patient care + 4 hours of administrative work I was able to make a viable living. With 80% of my patient load Medicare, the reimbursement cut plus the increased administrative work with PQRS, Functional Reporting, etc. I am left to completing 2013 and then closing the practice before the ICD-10 requires a huge computer upgrade cost. Too bad; 33 years as a PT with a great service to offer will leave many with significantly less medical providers to choose from.
Give each Medicare client their own "checkbook" of $3700.00 per year for PT. They will shop where they get the best bang for their buck. They will seek great practictioners, pay a fair fee.
$75/session for treatment primarily by aides will not stand up to $110/session for treatment by the skilled/licensed therapist. If there is any money left over in their checking account, it can carry over to the next year and so on. OR, Medicare should have facilities send in their payroll: If they employ 2 PT, 1 assistant and 2 aides, reimburse the treatment accordingly: 15 minutes at the PT rate, 15 minutes at the PT assistant rate and 30 minutes at the PT aide rate....Now that seems fair!

Posted by Rebecca Zerbst
on 3/29/2013 7:36 PM

I agree with the above comments. Why are PT's targeted so aggressively? Could someone explain to me how Chiropractors, who have the same education level as a DPT, are exempt from all the regulations and cuts and can continue to make a decent wage without being held to the impractical requirements of doctors prescriptions and signatures? This profession is quickly becoming less lucrative as the cost/benefit ratio is very top heavy. We have to become very creative in our delivery of care and have a stronger PAC/special interest group to represent us in Washington.

Posted by Stephanie Wakeman
on 3/29/2013 7:48 PM

The reimbursement for chiropractic is adjustment only under Medicare. This would be on average 30 dollars per visit.
Having a dual practice for many years has been a balancing act with income vs expense. Reduction in Medicare adds more stress to the bottom line.
The outside forces seem to be pushing the individual clinic owners to close and moving rehab back into the hospitals and industrial rehab centers. (What we had in the early 70s)
For private owners-hang on, be creative with finding additional sources of revenue and tighten your expenses.
You don't want to go back to working in a hospital with a loss of independence and some supervisor telling you it's time for your performance review.

Posted by Ernie Hackett PT DC
on 3/30/2013 9:08 AM

I agree with what most of you have posted. We as PTs are the base of the chopping block-the first to be hit. We provide a great service, do not use aides like some of our rival clinics, play by the rules and get the shaft. And I disagree with Stephanie, I think most PTs have more education than chiropractors. Yes, this is unfair. It seems like the only people not feeling the pinch are our politicians. Let's see them take a pay cut or pay some of their benefits out of their own pocket.

Posted by Chris Walters, PT
on 3/30/2013 10:28 AM

I've been a P.T. for 50+yrs and counting. Worked in every setting
possible for rehabilitative services. Had my own private practice
until 2006 and am now semi-retired, working part-time and
enjoying a stress-free professional life. Saw the "future"
years ago, mirroring the remarks of Cheri, Charles, Rebecca,
Stephanie et al. Where is the APTA in this, where are our
membership monies going, what is the PT-Pac doing for us???
The onerous medicare reimbursement policies are designed
to reduce, delay, avoid, and - in all ways - prevent timely and
fair payment. I feel for all the DPTs trying to pay their educational
loans, support a family and/or earn a decent living commensurate
with the efforts and commitments they have made.

Posted by Herschel Budlow
on 3/30/2013 6:05 PM

This is very discouraging for somebody like me who is thnking of opening a practice. I thought I am at a point in my career that I need to be on my own and do things that are of greater benefits to my patients and at the same time fulfiling for me. Does anybody see light at the end of the tunnel?

Posted by Muideen Kareem
on 3/31/2013 1:12 PM

I have been a PT for almost 25 years. You guys are looking at this the wrong way. Medicare's goal is not to service the patient, it is not part of the medical model. They are stuck with an every going and sick population of patients. Their only way to save money is to limit access or limit services, thus limiting payments. Limiting access limits care and increases mortality rates. Dead people do not need medicare or social security. It comes down to money not healthcare. You have to look at medicare like a contract lawyer would. Would can I get away with. Not like a healthcare professional what is the best way to help the patient.

Posted by Michael Mowery
on 4/1/2013 10:59 AM

The theme seems to be consistent with what I have seen from other forums and groups of PT's. The writing has been on the wall for a long time and now it is happening. Is there a light at the end of the tunnel? YES! Therapy companies that innovate what they do and how they provide services can trump the system. "Innovate or die" is now something to live by. Most people do not know the difference between different therapy practices. They do not really know what we do...

Posted by Curtis Mason
on 4/1/2013 4:09 PM

We in Hawaii thought we had finally figured out a way to "Move Forward" when "direct access" was approved in 2012, but not so. Medicare and our local BC/BS insurance company and of course W/C or no fault are not allowing patient treatment without a referral from the gate keeping Physician. The Medicare Advantage plans hardly allowed seniors to have any PT services at all and when they are permitted a few treatments their copay has increased from $15 to $45. I am unable to attract DPT's to my practice because they are expecting to be salaried accordingly. We can hardly get adequate reimbursement to keep paying BS/BA. I have recently read in the monthly AARP newspaper(yes I have been enjoying my PT career for many years now, but opened my private practice only 5 years)that the Physician shortage is so critical that they are expediting (shortening)med school and increasing the number of foreign trained Drs allowed per state. There have also been moves to have more nurse run practices and allow nursing schools to begin clinics for patients to be seen by nursing students. If Medicare and our EXTREMELY PROSPEROUS insurance companies that are controlling the healthcare system will abide such plans, what have PT's done wrong? Have PT's or our organization collectively offended some aspect of the system that now prefers to eliminate us? Are we pursuing the DPT to gain respect/credibility or are we educating ourselves right out of a healthcare market that will no longer be able to afford us? Let's focus on influencing those involved in healthcare reform that we are the BEST VALUE in the healthcare market while providing services that no one else can. We should be humble while letting them know that we have the knowledge and the tools that will help to restore function, mobility and strength without overstating the importance of the letters that follow our names.

Posted by Betty Fackler
on 4/2/2013 1:29 AM

I would like to first comment that I understand the frustration and "fear" that is in the comments above. I have been practicing for 14 years now and remember the same sentiment that occured during the BBA scare in 1996, 97, and 98.
As a private practitioner I would only comment that if the playing field were level in regards to hospital based practice and private practice reimbursement and policies, the private practice would win everytime. But remember in medicare they (hosptials) are only now having to work within the therapy caps and exception processes that the private practitioner has had to endure. "Critical Access Hospitals" by my understanding are still exempted, but for the most part other hospitals will also begin to feel our pain.
Also remember, Hospitals have much better lawyers and PAC money than we do, and when they begin to feel the pain, the rules will change.
Have "HOPE" and remember you get what you Vote for. If you voted for Obama, congratulations your candidate won, now enjoy the benefits of his administration.

Posted by Richard Luyster -> >HYa<N
on 4/2/2013 10:44 AM

I'm in the middle, perhaps unjustly. Betty is right, the "Value" is the important concept. But it is unlikely the "academics" at the APTA understand what that means...its sure not doctors earning 60k with double the regulations and requirements of just a year or two ago. Just a couple of us private practice PT's fought the co-pay issue in our state without the help of the APTA and won...not because we were right, but because we used the same methods the insurance lawyers constantly use against us. you cant tell me if 80,000 members were a union (i'm not advocating at the least) that we could'nt win on an issue occasionally! When we "play their game" by "their rules" we will start making progress, but our collective policy of capitualtion with only "strong verbal" opposition means we are NOT EVEN IN THE GAME!
My wish is that our apathy will lead to a quick collapse of the healthcare system so that those who caused, or allowed it, will be the ones required to fix it...not our children who we have let down. When we vote, suppport or oppose any issue, do so for what is best for our kids and not ourselves. That's real progress.
Trust me, therapy still has a major roll to play for America's future healthcare system in order for it to eventually work...I would encourage us to start that conversation sooner than later.

Posted by Norm Fasse
on 4/2/2013 1:46 PM

It seems like we are all agreeing on most of the issues. The question is: What are we really doing about it? I am sick and tired of getting the short end of the stick. We must stop “rolling over”. How many of you ever had their car worked on and when you picked it up tried to renegotiate the price? Oh, transmission repairs need to be pre-approved; sorry I can’t pay you for that part of the service. It is time to stand united and say: Sorry, we are no longer accepting Medicare patients! We are providing an invaluable service to our patients and the medical community knows it. For example: of all the dollars that are being spent on back-related injuries every year, less than 2% goes to Physical Therapy providers. But who spent the most time with these clients? WE DO. Let’s stop being DOOR MATS! We can not afford anymore cuts and continue to provide the same level of service.

Posted by Andreas Lohmar
on 4/4/2013 12:04 PM

What is happening with the bill to allow physical therapists to opt out of Medicare?

Posted by Cindy Newton
on 4/25/2013 1:01 PM

Cindy, crazy thing is that PT's are not even allowed to opt out of Medicare..unless they recently changed it. And another stupid thing is that if we wanted to charge cash for a Medicare patient, we are prohibited from doing so...it is illegal to accept cash payments from Medicare patients, even if there are no other clinics in the area to accept them. Maybe we need to implement a "don't ask, don't tell" policy? Any ideas?

Posted by David Gladysz
on 5/16/2013 1:11 PM

Is the APTA doing anything to get Congress to allow PTs to opt out of Medicare? Are we Medicare providers to our graves?? Seems like they are professionally biased against us. Something needs to be done.

Posted by Nancy Dewey
on 6/27/2013 7:12 PM

Glad Im not the only one that sees this issue as a major problem in our industry. Im a PTA who specializes in orthopedics, my employer hasn't been able to afford to give me any kind of raise or bonus for 3 years because of all the recent rei mbursement cutbacks, and yet my health insurance rates just went up since I turned 30.... Doesn't make any freaking sense.